Pool together for a flexible future

Integrated provider agreements may need to be renegotiated or abandoned as the implications of the health white paper make themselves felt

Partnership agreements under section 75 of the National Health Service Act 2006 were intended to offer NHS bodies and local authorities the flexibility to improve their services. Before then, patient care suffered from a bumpy transition between health and social care services. It was often disrupted while local authorities and primary care trusts figured out their respective responsibilities.

Both partners were offered the opportunity to join up their existing services or develop new, co-ordinated services by delegating functions, such as lead commissioning and integrated provision, as well as pooling their budgets.

The regulations allowed partners to exercise certain NHS functions and any health related functions if they were likely to lead to an improvement in the way they were carried out.

In order to measure the success of the arrangements, each agreement had to set out its respective aims, outcomes and targets and to be explicit as to how the services would be an improvement on those already provided and how they would promote existing joint working.

Flexibilities

While some did take up the new flexibilities, response was mixed. The full potential to bridge the health and social care divide often went unexploited. Some areas proved more problematic than others, with learning disabilities one of the easier areas to jointly commission, while others became subject to local politics and distrust, which inevitably delayed progress.

Pooling funds attempted to overcome old arguments over levels of contributions to a particular service, so expenditure could focus on users’ needs. Robust public accountability arrangements were put in place, but some budgets still became stretched and subject to overspending.

In other instances, pressure to lower budgets and management costs saw further uptake of flexibilities.

In a few exceptional instances, there was near complete integration between local authorities and their PCT partners. Co-extensive boundaries developed between PCTs and local authorities, which helped promote the shared vision for improving the health and wellbeing of their local population and contributed to a number of new partnership agreements being established.

While tensions between public sector partners remain and some pooled budgets and partnership agreements have been dissolved, the majority remain in place for the time being.

However, the impending demise of PCTs and the advent of GP consortia will undoubtedly offer future challenges for the success of lead and joint commissioning arrangements between the health and social sectors, particularly following health secretary Andrew Lansley’s recent statement to the health service committee.

Commissioning arrangements

Mr Lansley’s intention that local authorities will be able to veto GP consortia’s commissioning plans will mean they can be referred to the independent reconfiguration panel, and then on to the health secretary.

Moreover, we have yet to see how the Independent Commissioning Board will affect the existing section 75 arrangements and what new legislation will arise as a result of these new proposals.

Nevertheless, there is undoubtedly a recognition that the health service and local government will still need to work closely together to improve client care and to provide a joined up service.

The future for integrated provider arrangements might be considered to be more settled as local authorities, primary care, acute and foundation trusts all have the opportunity to adopt section 75 arrangements.

However, with the transforming community services programme and the government’s intention to open up the health market to any willing provider, section 75 integrated provider agreements are under threat.

Much will depend on whether PCT provider arms will integrate with other local health service bodies or whether they will become independent health suppliers through the likes of limited companies and social enterprises.

As a result many existing section 75 integrated provider agreements may have to come to an end, or at the very least be renegotiated.

The future of section 75 agreements remains very much in doubt. But the challenges posed by budget constraints and the need to cut managerial costs, while maintaining frontline services, will demand that the health service and local government continue to work in partnership and be more innovative in the way they provide their services. l